(3) Lecture 19: Neck Injuries and On-field Assessment Flashcards
Goals of an Emergency Field Assessment
Primary
- ABC, Roll, Equipment removal, spinal board
Secondary
- history/subjective
- field assessment
- transport
- sideline assessment (what’s wrong? can they play?)
- return to game
What should you be thinking while you are sprinting onto the field?
Is the athlete at risk?
- life vs limb (activate EAP/load + go)
Is the area stable?
Can they continue w/o significant risk (safely + effectively)
How do I get the athlete off the field?
- walk, assist, non-weight bearing? immobilized/boarded
On-Field Assessment
Unconscious vs Conscious
Unconscious - activate EAP immediately
Then primary assessment
- poor result = activate EAP
Primary Survey
Determine existence of potentially life-threatening situations
UABC
U - Responsiveness (Unresponsive? alert? verbal?
Airway
Breathing
Circulation
Check for spinal injury if suspected mechanism
YES to any of those things - “load + go”, activate EAP
NO: secondary Ax (assessment)
Spinal Injury
Supine (on back) - ensure ABC’s and stabilize
Prone (on belly) - may need to reposition to ensure ABC’s
Athlete with suspected neck injury
- Stabilize the C-spine (until neck injury is ruled out)
- Assure athlete and tell them not to move - be firm + assertive
- Get brief history + subjective report
- Begin your palpation + assessment
Subjective spinal
Use 8 questions to help decide course of action
- Can you tell me what happened (MOI)
- Do you have pain in your head?
- Do you have pain in your neck?
- Do you have pain in your back?
- Do you have tingling or numbness in any of your arms or legs? - get specifics
- Do you have pain anywhere else?
- Can you wiggle your toes? - check both sides
- Can you wiggle your fingers? - check both sides
Stinger/Burner Mechanism
best case scenario; risk of injuring brachial plexus
- hits FRONT of player
Mechanism
- nerve traction or compression especially involving C5 and C6
1. Shoulder distracted down from head and neck = stretch
2. Blow to supraclavicular fossa (ex. getting hit by stick/ball) = lax
3. Forced neck extension and rotation to injured side = pinch
Stinger/Burner Signs + Symptoms
- RARELY neck pain (down middle of spinal processes)
- UNILATERAL symptoms
- can be transient (short time)
- SENSORY CHANGES (C5/6) distribution
- motor changes C5/6 (shoulder abduction/external rotation + elbow flexion
Heals quickly often by time they reach the sideline
Neck pain
NOT pain on side of the neck
usually pain down middle of spinal processes
Return to Play for Stinger/Burner
Same game return to play IF
- quick resolution of symptoms (<5mins)
- full ROM
- full strength - able to protect themselves
- ability to complete sport specific skills
- mentally ready
C- spine injury MOI
usually one of two mechanisms:
- Axial load = vertical compression
- burst fracture = everything lined straight up - Compression = flexion injury
- anterior portion compresses and posterior portion elongates
C- spine injury on-field findings
- neck pain
- pain on CENTRAL palpation (spinous process)
- bilateral neural findings (myotomes/dermatomes)
- upper + lower extremity findings
To board or not to board neck injuries
Practice is shifting from blanket immobilisation to a selective approach
Palpation of the injured C-spine athlete
- need to palpate upper back, neck, shoulder, clavicle and sternum
- failure to do this means paralysis or death
- know the order
Dermatomes
go through them
Myotomes
go through them
Canadian C spine Rules
- High-risk factors that mandate RADIOGRAPHY (Yes = X-Ray; No = #2)
- Age > 65 years
- Dangerous mechanism or paraesthesis (tingling) in extremities - Low-risk factors that allow safe assessment of ROM (Yes = #3; No = X-Ray)
- NO midline C-spine tenderness
- Delayed onset of neck pain
- Ambulatory at any time
- Sitting position
- Simple rearend MVC - Able to actively rotate neck? → 45° left and right (able = no X-Ray, unable = X-Ray)
Dangerous mechanisms: fall from elevation, axial load to head (diving). MVC high speed
Stinger/Burner vs Spinal Cord Injury
Stinger/Burner
- unilateral
- rarely involve lower extremities b/c brachial plexus doesn’t innervate there
- transient (can heal quickly)
- sensory (C5/6 dermatome)
- weakness
Spinal cord/C-spine injury
- bilateral
- upper AND lower extremities
- transient or prolonged/permanent
- sensory w/ possible total loss of sensation
- weakness/paralysis
Log Roll
Prior to roll
- make sure helmet is stable
- need to use CROSS ARM technique so arms unwind as roll is performed
Leader uses commands: “PREPARE TO ROLL” and “ROLL” - assistants follow
C- spine immobilization clinical recommendation
when a C-spine injury is suspected, the spine should be immobilized in NEUTRAL position
- can reduce spinal cord compromise
- may facilitate airway management
there are 3 contraindications to moving C-spine to neutral
Contraindications to moving C-spine to neutral
- Movement causes or increases pain, neurologic symptoms or muscle spasm compromising the airway
- there is RESISTANCE to movement
- patient expresses apprehension
Helmet Facemask Removal Tools
Study 1: cordless screwdriver is more efficient than FM extractor
Study 2: cordless screwdriver should be used as primary tool for face mask removal + should have a backup tool
“Don’t Lose Your Head”
Keep them in as much equipment as possible as long as they’re safe and secure
